During the assembly elections held in Kerala in April–May 2006, VS Achuthanandan defeated Satheesan Pacheeni of the United Democratic Front by a margin of 20,017 votes in Malampuzha constituency in Palakkad district. He was sworn in as Chief Minister of Kerala on 18 May 2006, with his 21-member cabinet. Aged 82 years and 7 months at time, he was the oldest Chief Minister of Kerala, and one of the oldest in the whole India. It is noticeable that he had been denied a party ticket to contest elections just two months before he sworn in. He became the 11th Chief Minister of Kerala. On 12 July the CPM Polit bureau and Central Committee removed him from the PB for his stands taken in relation to the accusation and legal procedures against Pinarayi Vijayan in his reported involvement in the Lavlin bribery.

While he was the chief minister of the state, he had to frequently face struggle with Pinarayi Vijayan, the powerful head of the party which led the ruling coalition. Both of them headed for showdowns, which often prevented Achuthanandan from taking strong decisions. This power struggle often turned worse as both attacking each other. As a result, this group fight created two set of party leaders and even the ministers in the government, the name called the VS group and the Pinarayi group.[28][29]
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